Cerebral infarction from delayed cerebral ischemia (DCI) represents the leading cause of mortality and morbidity in patients surviving initial subarachnoid hemorrhage (SAH).The aim of this project is to perform an international survey about practical issues (i.e. diagnosis, monitoring, prophylaxis and management) of cerebral vasospasm associated with DCI in SAH adult (> 18 years old) patients, requiring intensive care unit (ICU) admission. Main endpoints will be to examine a) diagnostic procedures; b) monitoring tools, c) prevention strategies and d) management options.

Target Audience: All Members

Duration: 10 minutes

Contact: Fabio Silvio Taccone

Survey Closes: May 31, 2022

Acute seizures often occur at the time of or in close proximity to brain or systemic insult. Clinical seizures alone account for 40% of all afebrile seizures, with a 3.6% lifetime risk. Last decade has seen a 10-fold increase in continuous EEG monitoring (cEEG) that has resulted in detection of non-convulsive seizures and several epileptiform patterns. A recent large multi-center study demonstrated that a large number of the patients undergoing cEEG receive anti-seizure medications (ASMs) during the acute hospitalization based on cEEG findings, with significant variability across the three centers. To date, there is no guidelines for the optimal duration of treatment after acute symptomatic seizures. Due to lack of direct evidence guiding the management practice of acute symptomatic seizures and EEG abnormalities, it is unclear how long these patients should be treated with ASM. The investigators of this survey have formed a consortium called post-acute symptomatic seizure investigation and outcomes network (PASSION) which has been funded to prospectively enroll patients with acute seizures to examine long-term seizures and neurocognitive outcomes. As part of their Our aim through this study is to evaluate the management practices across the United States and identify any common practices, which will assist with future study design for multi-center randomized control trial of ASM in this patient population.

Target Audience: All Members

Duration: 10 minutes

Contact:  Sahar Zafar

Survey Closes: May 31, 2022

Background: Patients with neurologic compromise often require emergency measures to promote brain function. One established clinical practice for patients with neurological compromise may include monitored drainage of cerebrospinal fluid. Patients with cerebrospinal drainage, including externalized ventricular drains (EVDs) and lumbar drains (LD) may experience high rates of infection or other device related complications. The mortality rate of patients with these devices remains high, and according to some reports, may approach 40%. Although nurses in neuroscience intensive care units and stepdown units often care for these patients, specific practices are known to vary widely.

Purpose: The proposed survey, entitled “Clinician survey- Knowledge and Clinical use of Externalized ventricular drains and lumbar drain” intends to explore the specific practices of nurses in relation to care of EVDs in an effort to identify best practices.

Target Audience: All Members

Duration: 10 minutes

Contact: Millie Hepburn

Survey Closes: May 31, 2022

Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage continues to be associated with high levels of morbidity and mortality. This complication had long been thought to be secondary to severe cerebral vasospasm, but now expert opinion favors a multi-factorial etiology, opening the possibility of new therapies. To date, no definitive treatment option has been recommended as standard of care, highlighting a need for further research into potential therapies. Milrinone has been identified as a promising therapeutic agent possessing a mechanism of action for the reversal of cerebral vasospasm, as well as potentially anti-inflammatory effects to treat the underlying etiology of DCI. Both intraarterial and intravenous administration have been evaluated for the treatment of DCI in single center case series and cohorts, and both appear safe and associated with improved clinical outcomes. Recent results have also brought attention to the potential benefit of early, more aggressive dosing and titration of milrinone being associated with improved outcomes. Limitations exist within the available data, however, and questions remain about the generalizability of results across a broader spectrum of patients suffering from DCI. There is currently no standardized protocol for the use of milrinone for the DCI indication and the prevalence of use is unknown. The purpose of this survey is to assess the current utilization of milrinone and practice habits and determine future direction for larger clinical trials evaluating milrinone efficacy for DCI.

Target Audience: MDs, APs, Pharmacists, Trainees (fellows, residents, medical students)

Duration: 10 minutes

Contact: Michael Schontz

Survey Closes: June 30, 2022

Target Audience: All Members

Duration: 5 minutes

Contact: Abhijit Lele

Survey Closes: May 31, 2022